Creating the ICU of the future: patient-centred design to optimise recovery

Background Intensive Care survival continues to improve, and the number of ICU services is increasing globally. However, there is a growing awareness of the detrimental impact of the ICU environment on patients, families, and staff. Excessive noise and suboptimal lighting especially have been shown to adversely impact physical and mental recovery during and after an ICU admission. Current ICU designs have not kept up with advances in medical technology and models of care, and there is no current ‘gold-standard’ ICU design. Improvements in ICU designs are needed to optimise care delivery and patient outcomes. Methods This manuscript describes a mixed-methods, multi-staged participatory design project aimed at redesigning and implementing two innovative ICU bedspaces. Guided by the action effect method and the consolidated framework for implementation research, the manuscript describes the processes taken to ensure the patient-centred problems were properly understood, the steps taken to develop and integrate solutions to identified problems, and the process of implementation planning and rebuilding in a live ICU. Results Two innovative ICU bedspaces were rebuilt and implemented. They feature solutions to address all identified problems, including noise reduction, optimisation of lighting, access to nature via digital solutions, and patient connectivity and engagement, with solutions developed from various specialty fields, including IT improvements, technological innovations, and design and architectural solutions. Early evaluation demonstrates an improved lighting and acoustic environment. Conclusions Optimising the ICU bedspace environment and improving the lighting and acoustic environment is possible. The impact on patient outcomes needs to be evaluated. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-023-04685-2.


Materiality & acoustics
Reduce environmental stressors by: Sound produced by staff can be reduced through environmental monitoring with visual sound feedback.

Materiality & acoustics
Reduce environmental stressors by: Sound produced by staff will be reduced through ongoing education.

Materiality & acoustics
Reduce environmental stressors by: Sound produced shall be reduced through silent alarms / alarm management solutions / prioritising alarms.

Materiality & acoustics
Key requirements of the final product are that: The solution shall reduce the amount of alarms produced by minimum 25%.

Materiality & acoustics
Reduce environmental stressors by: Sound produced shall be reduced by including the ability to adjust the equipment remotely / from nurses computer.

Materiality & acoustics
Reduce environmental stressors by: Sound produced will be reduced by ensuring bins close softly and quietly.

Materiality & acoustics
Reduce environmental stressors by: Sound produced will be reduced by ensuring bins move more quietly.

Materiality & acoustics
Reduce environmental stressors by: Sound produced will be reduced by ensuring the bins are placed in a location where they can be changed / emptied with minimum disturbance to the patient Materiality & acoustics Reduce environmental stressors by: Sound produced shall be reduced by ensuring that all doors close quietly Materiality & acoustics Door closure Sound produced will be reduced by ensuring that all doors are closed as the default position Materiality & acoustics Reduce environmental stressors by: Sound produced can be reduced by ensuring there's a more gradual increase of water flow in the taps in the bedspace Materiality & acoustics Reduce environmental stressors by: Sound produced will be reduced by ensuring appropriate impact protection in walls -e.g.aiming for RW 55 Materiality & acoustics Reduce environmental stressors by: Sound shall be delivered from the screen / PES directly to patient / speaker next to patient's head.

Materiality & acoustics
Reduce environmental stressors by: Sound delivered from the screen / PES directly to patient / speaker next to patient's head shall be individually controlled / adjusted.

Materiality & acoustics
Reduce environmental stressors by: The solution will be optimised for sleep.

Materiality & acoustics
Optimising the sleep environment by: The solution will ensure darkness for patients at night.

Materiality & acoustics
Optimising the sleep environment by: The solution shall miminise / remove light pollution at night.

Materiality & acoustics
Optimising the sleep environment by: The solution will reduce light from monitors and displays at night.

Materiality & acoustics
Optimising the sleep environment by: The solution will consider soft night light for staff at the computer station.

Materiality & acoustics
Optimising the sleep environment by: The solution will consider soft night light for staff to allow completion of clinical duties and observations, without disturbing the patient.

Materiality & acoustics
Optimising the sleep environment by: The solution considers soft, soundless and backlit computer keyboards or soft night light for staff visibility Materiality & acoustics Optimising the sleep environment by: The solution considers the ability to modify bedspace temperature and individualise / diurnal temperature variations.

Materiality & acoustics
Optimising the sleep environment by: The solution will reduce the need for nocturnal disturbance and care activities.

Materiality & acoustics
Optimising the sleep environment by: The solution shall provide optimal acoustics.

Materiality & acoustics
Optimising the sleep environment by: The solution shall provide a quiet nocturnal space.

Materiality & acoustics
Optimising the sleep environment by: Biomedical device monitoring operates wirelessly whenever possible, including The new prototype will: The solution shall incorporate technology that supports a better experience for patients and their loved ones.168 Technology & Integration Design of ICT solutions must consider the patient first and strive to improve their experience: ICT technology will deliver integrated rather than proprietary solutions.

169
Technology & Integration Design of ICT solutions must consider the patient first and strive to improve their experience: ICT technology solutions will put the patient at the forefront that support high levels of engagement in their treatment, care, recovery and rehabilitation processes.

170
Technology & Integration Design of ICT solutions must consider the patient first and strive to improve their experience: ICT technology solutions will not inhibit interaction between the patient and those providing care or other services.171 Technology & Integration Clinician engagement in the selection and design of ICT for the new prototype is essential, to ensure that these systems are fit for purpose and support efficient clinical processes: ICT solutions will be easy to use, integrated and always reliable.

172
Technology & Integration Clinician engagement in the selection and design of ICT for the new prototype is essential, to ensure that these systems are fit for purpose and support efficient clinical processes: Systems will be integrated wherever possible.The solution should also be capable of integrating with a number of other systems to provide the following functionality: The solution may indicate staff presence via the RTLS solution that displays staff names on the screen when entering the room.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The network shall be capable of supporting multiple medical equipment devices.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The network shall be capable of supporting existing medical equipment devices.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The network shall be capable of supporting multiple vendor solutions.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The network will be continuously monitored by an enterprise grade network monitoring solution. 183 Technology & Integration The bedspace will require a robust, highly available Medical Grade Network.
The network will be designed with consideration for the IEC80001-2-3: Application of Risk Management for IT networks incorporating medical devices -Part 2-3: Guidance for wireless networks.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The wireless network will have seamless connectivity.

Technology & Integration
The bedspace will require a robust, highly available Medical Grade Network.
The wireless network will be high-grade in the two bed-spaces being updated at TPCH and have complete room coverage as demonstrated by wireless heatmap.186 Technology & Integration The bedspace will require a robust, highly available Medical Grade Network.
The solution will minimise how often it touches the patient / QH network and utilise the guest network whenever possible.187Technology&IntegrationThebedspacewillrequirearobust, highly available Medical Grade Network.Wireless Biomedical Device connectivity should be via the ICT converged network.188Technology&IntegrationThebedspacewillrequire a robust, highly available Medical Grade Network.Wireless Biomedical Device connectivity will cater for appropriate levels of security to protect data and devices from malicious activity.189Technology&IntegrationAdequate planning for UPS and emergency power supplies is critical.Critical ICT systems & networks will be connected to emergency power feeds, including UPS for those systems that are unable to handle a loss of power.190Technology& Integration Software design Devices and equipment will communicate and integrate within bedspace.
191 Technology & IntegrationSoftware design Relevant data will communicate with hub / computer external to bedspace (e.g.nurses station).